Retinotopic mapping reveals extrastriate cortical basis of homonymous quadrantanopia

Unexplained Progressive Visual Field Loss in the Presence of Normal Retinotopic Maps

Lesions of primary visual cortex or its primary inputs typically result in retinotopically localized scotomas. Here we present an individual with unexplained visual field loss and deficits in visual perception in the absence of structural damage to the early visual pathway or lesions in visual cortex. The subject, monocular from an early age, underwent repeated perimetry tests over 8 years demonstrating severe anopia of the lower hemifield, and a clockwise progression of the loss through her upper left visual field. Her visual impairment was evident in a number of standardized tests and psychophysics, especially in tasks assessing spatial integration using illusory contours. However, her intellectual ability was intact and her performance in some other tasks assessing color vision or object detection in scenes was normal. We employed functional magnetic resonance imaging (fMRI), electroretinography and visually evoked potentials. Surprisingly, in contrast to the participant's severe anopia, we found no evidence of abnormal function of her early visual pathways. Specifically, we performed retinotopic mapping using population receptive field (pRF) analysis to map the functional organization of visual cortex in the anopic participant and three control participants on two occasions three and a half years apart. Despite the behavioral visual field loss, her retinotopic maps and pRF parameters in visual areas V1-V3 were qualitatively normal. Further behavioral experiments confirmed that this discrepancy was not trivially explained by the difference between stimuli used for retinotopic mapping and perimetry. Structural T1 scans were normal at both time points, and volumetric analysis of white and gray matter tissue on the segmented T1 volumes did not reveal any abnormalities or deterioration over time. Our findings suggest that normal functional organization of early visual cortex without evident structural damage to the early visual pathway as disclosed by the techniques employed in this study does not necessarily guarantee conscious perception across the visual field.

Prevention of postoperative visual field defect after the occipital transtentorial approach: anatomical study

OBJECTIVE

A postoperative visual field defect resulting from damage to the occipital lobe during surgery is a unique complication of the occipital transtentorial approach. Though the association between patient position and this complication is well investigated, preventing the complication remains a challenge. To define the area of the occipital lobe in which retraction is least harmful, the surface anatomy of the brain, course of the optic radiations, and microsurgical anatomy of the occipital transtentorial approach were examined.

METHODS

Twelve formalin-fixed cadaveric adult heads were examined with the aid of a surgical microscope and 0° and 45° endoscopes. The optic radiations were examined by fiber dissection and MR tractography techniques.

RESULTS

The arterial and venous relationships of the lateral, medial, and inferior surfaces of the occipital lobe were defined anatomically. The full course of the optic radiations was displayed via both fiber dissection and MR tractography. Although the stems of the optic radiations as exposed by both techniques are similar, the terminations of the fibers are slightly different. The occipital transtentorial approach provides access for the removal of lesions involving the splenium, pineal gland, collicular plate, cerebellomesencephalic fissure, and anterosuperior part of the cerebellum. An angled endoscope can aid in exposing the superior medullary velum and superior cerebellar peduncles.

CONCLUSIONS

Anatomical findings suggest that retracting the inferior surface of the occipital lobe may avoid direct damage and perfusion deficiency around the calcarine cortex and optic radiations near their termination. An accurate understanding of the course of the optic radiations and vascular relationships around the occipital lobe and careful retraction of the inferior surface of the occipital lobe may reduce the incidence of postoperative visual field defect.

Organization of area hV5/MT+ in subjects with homonymous visual field defects

Damage to the primary visual cortex (V1) leads to a visual field loss (scotoma) in the retinotopically corresponding part of the visual field. Nonetheless, a small amount of residual visual sensitivity persists within the blind field. This residual capacity has been linked to activity observed in the middle temporal area complex (V5/MT+). However, it remains unknown whether the organization of hV5/MT+ changes following early visual cortical lesions. We studied the organization of area hV5/MT+ of five patients with dense homonymous defects in a quadrant of the visual field as a result of partial V1+ or optic radiation lesions. To do so, we developed a new method, which models the boundaries of population receptive fields directly from the BOLD signal of each voxel in the visual cortex. We found responses in hV5/MT+ arising inside the scotoma for all patients and identified two possible sources of activation: 1) responses might originate from partially lesioned parts of area V1 corresponding to the scotoma, and 2) responses can also originate independent of area V1 input suggesting the existence of functional V1-bypassing pathways. Apparently, visually driven activity observed in hV5/MT+ is not sufficient to mediate conscious vision. More surprisingly, visually driven activity in corresponding regions of V1 and early extrastriate areas including hV5/MT+ did not guarantee visual perception in the group of patients with post-geniculate lesions that we examined. This suggests that the fine coordination of visual activity patterns across visual areas may be an important determinant of whether visual perception persists following visual cortical lesions.

Visual Memory and Visual Perception Recruit Common Neural Substrates

This human neuroimaging review aims to determine the degree to which visual memory evokes activity in neural regions that have been associated with visual perception. A visual perception framework is proposed to identify cortical regions associated with modality-specific processing (i.e., visual, auditory, motor, or olfactory), visual domain-specific processing (i.e., “what” versus “where,” or face versus visual context), and visual feature-specific processing (i.e., color, motion, or spatial location). Independent assessments of visual item memory studies and visual working memory studies revealed activity in the appropriate cortical regions associated with each of the three levels of visual perception processing. These results provide compelling evidence that visual memory and visual perception are associated with common neural substrates. Furthermore, as with visual perception, they support the view that visual memory is a constructive process, in which features or components from disparate cortical regions bind together to form a coherent whole.

Higher visual functions in the upper and lower visual fields: A pilot study in healthy subjects

Visual perception is not identical in the upper and lower visual hemifields. The mechanisms behind this difference can be found at the retinal, cortical, or higher attentional level. In this study, a new visual test battery, that involves real-time comparisons of complex visual stimuli, such as shape of objects, and speed of moving dot patterns, in the upper and lower visual hemifields, is presented. This study represents, to our knowledge, the first to implement such a visual test battery in an immersive environment composed of a hemisphere, in order to present visual stimuli in precise regions of the visual field. Ten healthy volunteers were tested in this pilot study. The results showed a higher accuracy in the image matching when the visual test was performed in the lower visual hemifield.

Visualizing the blind brain: brain imaging of visual field defects from early recovery to rehabilitation techniques

Visual field defects (VFDs) are one of the most common consequences observed after brain injury, especially after a stroke in the posterior cerebral artery territory. Less frequently, tumors, traumatic brain injury, brain surgery or demyelination can also determine various visual disabilities, from a decrease in visual acuity to cerebral blindness. Visual field defects is a factor of bad functional prognosis as it compromises many daily life activities (e.g., obstacle avoidance, driving, and reading) and therefore the patient's quality of life. Spontaneous recovery seems to be limited and restricted to the first 6 months, with the best chance of improvement at 1 month. The possible mechanisms at work could be partly due to cortical reorganization in the visual areas (plasticity) and/or partly to the use of intact alternative visual routes, first identified in animal studies and possibly underlying the phenomenon of blindsight. Despite processes of early recovery, which is rarely complete, and learning of compensatory strategies, the patient's autonomy may still be compromised at more chronic stages. Therefore, various rehabilitation therapies based on neuroanatomical knowledge have been developed to improve VFDs. These use eye-movement training techniques (e.g., visual search, saccadic eye movements), reading training, visual field restitution (the Vision Restoration Therapy, VRT), or perceptual learning. In this review, we will focus on studies of human adults with acquired VFDs, which have used different imaging techniques (Positron Emission Tomography, PET; Diffusion Tensor Imaging, DTI; functional Magnetic Resonance Imaging, fMRI; Magneto Encephalography, MEG) or neurostimulation techniques (Transcranial Magnetic Stimulation, TMS; transcranial Direct Current Stimulation, tDCS) to show brain activations in the course of spontaneous recovery or after specific rehabilitation techniques.

Population receptive field analysis of the primary visual cortex complements perimetry in patients with homonymous visual field defects

Injury to the primary visual cortex (V1) typically leads to loss of conscious vision in the corresponding, homonymous region of the contralateral visual hemifield (scotoma). Several studies suggest that V1 is highly plastic after injury to the visual pathways, whereas others have called this conclusion into question. We used functional magnetic resonance imaging (fMRI) to measure area V1 population receptive field (pRF) properties in five patients with partial or complete quadrantic visual field loss as a result of partial V1+ or optic radiation lesions. Comparisons were made with healthy controls deprived of visual stimulation in one quadrant ["artificial scotoma" (AS)]. We observed no large-scale changes in spared-V1 topography as the V1/V2 border remained stable, and pRF eccentricity versus cortical-distance plots were similar to those of controls. Interestingly, three observations suggest limited reorganization: (i) the distribution of pRF centers in spared-V1 was shifted slightly toward the scotoma border in 2 of 5 patients compared with AS controls; (ii) pRF size in spared-V1 was slightly increased in patients near the scotoma border; and (iii) pRF size in the contralesional hemisphere was slightly increased compared with AS controls. Importantly, pRF measurements yield information about the functional properties of spared-V1 cortex not provided by standard perimetry mapping. In three patients, spared-V1 pRF maps overlapped significantly with dense regions of the perimetric scotoma, suggesting that pRF analysis may help identify visual field locations amenable to rehabilitation. Conversely, in the remaining two patients, spared-V1 pRF maps failed to cover sighted locations in the perimetric map, indicating the existence of V1-bypassing pathways able to mediate useful vision.

Memory for color reactivates color processing region

Memory is thought to be constructive in nature, where features processed in different cortical regions are synthesized during retrieval. In an effort to support this constructive memory framework, the present functional magnetic resonance imaging study assessed whether memory for color reactivated color processing regions. During encoding, participants were presented with colored and gray abstract shapes. During retrieval, old and new shapes were presented in gray and participants responded 'old-colored', 'old-gray', or 'new'. Within color perception regions, color memory related activity was observed in the left fusiform gyrus, adjacent to the collateral sulcus. A retinotopic mapping analysis indicated this activity occurred within color processing region V8. The present feature specific evidence provides compelling support for a constructive view of memory.

New approaches to visual rehabilitation for cortical blindness: outcomes and putative mechanisms

Cortical blindness is a chronic loss of vision following damage to the primary visual cortex (V1) or its postchiasmal afferents. Such damage is followed by a brief period of spontaneous plasticity that rarely lasts beyond 6 months. Following this initial phase, the visual deficit is thought to be stable, intractable, and permanent. Cortically blind subjects demonstrate spontaneous oculomotor adaptations to their deficits that can be further improved by saccadic localization training. However, saccadic training does not improve visual sensitivity in the blind field. In contrast, recent studies by a number of independent groups suggest that localized, repetitive perceptual training can improve visual sensitivity in the blind field, although mechanisms underlying the observed recovery remain unclear. This review discusses the current literature on rehabilitative strategies used for cortical blindness with emphasis on the use of perceptual training methods. The putative mechanisms that underlie the resulting, training-induced visual improvements are then outlined, along with the special challenges posed to their elucidation by the great variability in the extent and sometimes nature of the V1 damage sustained in different individuals.

Residual Neurovascular Function and Retinotopy in a Case of Hemianopia

Introduction: For occipital cortex strokes resulting in vision disorders, questions about the viability of residual visual cortex remain. Clinical Picture: In a patient with a one-year-old, left, complete, homonymous hemianopia due to a right, posterior cerebral artery, ischaemic infarct, we assessed the visual cortex with fMRI retinotopic mapping prior to starting vision restoration therapy. Outcome: The patient was found to have residual neurovascular function and retinotopic representation in the surviving visual cortex around the infarcted area. Conclusion: The ability to respond to stimuli in part of the blind field, though not consciously perceived, suggests the potential for recovery. Key words: fMRI, Retinotopic mapping, Stroke

Functional MT + lesion impairs contralateral motion processing

Human motion processing region MT + is retinotopically organized with perception of and attention to motion in the right visual field preferentially associated with left MT + activity and vice versa. However, the degree to which MT + is crucial for motion processing is uncertain. We report an epilepsy patient with visual symptoms early in his seizure evolution and a left temporal-occipital seizure onset electrographically in whom we hypothesized a functional left MT + lesion. The patient was impaired in his right but not left visual field on a hemifield motion attention task and demonstrated worse performance on a hemifield picture identification task when pictures implying motion were presented in the right as opposed to the left visual field. Functional MRI (fMRI) during a full-field motion detection task activated right MT + but failed to activate left MT + despite activating both left and right MT + in each of 10 controls. Furthermore, fMRI during a hemifield motion attention task also showed a lack of left MT + attention effects in the patient. Together these results suggest that MT + is necessary for normal motion processing.

Quadrantic deficit reveals anatomical constraints on selection

Our conscious experience is of a seamless visual world, but many of the cortical areas that underlie our capacity for vision have a fragmented or asymmetrical representation of visual space. In fact, the representation of the visual field is fragmented into quadrants at the level of V2, V3, and possibly V4. In theory, this division could have no functional consequences and therefore no impact on behavior. Contrary to this expectation, we find robust quadrant-level interference effects when attentively tracking two moving targets. Performance improves when target objects appear in separate quadrants (straddling either the horizontal or vertical meridian) compared with when they appear the same distance apart but within a single quadrant. These quadrant-level interference effects would not be predicted by cognitive theories of attention and tracking that do not take anatomical constraints into account. Quadrant-level interference strongly suggests that cortical areas containing a noncontiguous representation of the four quadrants of the visual field (i.e., V2, V3, and V4) impose an important constraint on attentional selection and attentive tracking.

Altered figure-ground perception in monkeys with an extra-striate lesion

The visual system binds and segments the elements of an image into coherent objects and their surroundings. Recent findings demonstrate that primary visual cortex is involved in this process of figure-ground organization. In the primary visual cortex the late part of a neural response to a stimulus correlates with figure-ground segregation and perception. Such a late onset indicates an involvement of feedback projections from higher visual areas. To investigate the possible role of feedback in figure-ground perception we removed dorsal extra-striate areas of the monkey visual cortex. The findings show that figure-ground perception is reduced when the figure is presented in the lesioned hemifield and perception is normal when the figure appeared in the intact hemifield. In conclusion, our observations show the importance for recurrent processing in visual perception.

Discordance between subjective perimetric visual fields and objective multifocal visual evoked potential-determined visual fields in patients with hemianopsia

PURPOSE

To investigate the concordance between subjectively and objectively acquired visual fields in patients with subjectively determined hemianopsia.

DESIGN

Retrospective observational study.

METHODS

Ten patients, six men and four women, ranging in age from 28 to 68 years, were studied. Goldmann or Humphrey perimeters were used to obtain the subjectively determined visual fields for up to 25 degrees of eccentricity, and the VERIS Scientific System (Electro-Diagnostic Imaging, San Francisco, California, USA) was used to record multifocal visual evoked potential [VEPs] (mfVEPs) to obtain the objective visual fields. Each of the 60 black-and-white segments of the checkerboard stimulus was alternated according to a binary m sequence. The first slices of the second-order kernels were extracted and analyzed.

RESULTS

In five cases, the visual field loci where the mfVEPs were within normal limits corresponded to the scotomatous areas obtained by conventional perimetry. In these discordant cases, the lesions (e.g., arteriovenous malformation) were located in the occipital lobe. Two of these cases had a complete recovery of the subjective visual field. The lesions of the concordant cases were located outside the occipital lobe (e.g., pituitary adenoma). In these cases, no visual field improvement was seen. The temporal crescent syndrome was ruled out in patients with posterior lesions by computed tomography (CT) or magnetic resonance imaging (MRI) findings.

CONCLUSIONS

In some patients with occipital lesions, the subjective and objective visual field results are discordant, and some of them will show a recovery of the visual field deficits.

The nature of memory related activity in early visual areas

Memory for visual items can evoke activity in visual processing regions, which is typically assumed to reflect conscious remembering. However, based on previous findings, we hypothesized that such activity in early visual areas (BA17, BA18) may reflect priming, a form of nonconscious memory. We tested this hypothesis in two fMRI experiments with similar stimulus protocols, but explicit or implicit task instructions. During initial runs, abstract shapes were presented to either side of fixation, filled with parallel lines of random orientation and color. In subsequent runs, old and new shapes (plus related shapes in Experiment 2) were presented at fixation. In Experiment 1, participants were instructed to remember each shape and its spatial location during initial runs; during subsequent runs they classified each shape as old and on the "left", old and on the "right", or "new". A right fusiform gyrus region (BA18) and a left lingual gyrus region (BA18) were preferentially associated with shapes previously presented on the left and right, respectively. In support of our hypothesis, this early visual area activity was independent of response accuracy for spatial location. In Experiment 2, for each shape, participants identified parallel line orientation relative to horizontal. Consistent with our hypothesis, specific neural activity was observed in early visual regions (BA17, BA18, extending into BA19), with old activity greater than related and new activity (likely reflecting priming). The results of these experiments provide convergent evidence that memory related early visual area activity (BA17, BA18) can reflect nonconscious processing.

Objective perimetry using the multifocal visual evoked potential in central visual pathway lesions

AIMS

To examine the ability of the multifocal pattern visual evoked potential (mVEP) to detect field loss in neurological lesions affecting the visual pathway from the chiasm to the cortex.

METHOD

The mVEPs recorded in the clinic were retrospectively reviewed for any cases involving central neurological lesions. Recordings had been performed with the AccuMap V1.3 objective perimeter, which used an array of four bipolar occipital electrodes to provide four differently oriented channels for simultaneous recording. 19 patients with hemianopias were identified. Of these there were 10 homonymous hemianopias with hemifield type loss, two bitemporal hemianopias, and seven homonymous hemianopias with quadrantanopic distribution. A comparison with subjective field results and CT/MRI findings was done to determine the relation between the two methods of visual field mapping and any relation with the anatomical location of the lesion and the mVEP results.

RESULTS

In all hemianopic type cases (12) the defect was demonstrated on the mVEP and showed good correspondence in location of the scotoma (nine homonymous and two bitemporal). The topographic distribution was similar but not identical to subjective testing. Of the seven quadrantanopic type hemianopias, only four were found to have corresponding mVEP losses in the same areas. In the three cases where the mVEP was normal, the type of quadrantanopia had features consistent with an extra-striate lesion being very congruous, complete, and respecting the horizontal meridian.

CONCLUSIONS

The mVEP can detect field loss from cortical lesions, but not in some cases of homonymous quadrantanopia, where the lesion may have been in the extra-striate cortex. This supports the concept that the mVEP is generated in V1 striate cortex and that it may be able to distinguish striate from extra-striate lesions. It implies caution should be used when interpreting "functional" loss using the mVEP if the visual field pattern is quadrantic.

Human MT+ mediates perceptual filling-in during apparent motion

During apparent motion, spatially distinct items presented in alternation cause the perception of a visual stimulus smoothly traversing the intervening space where no physical stimulus exists. We used fMRI to determine whether the perceptual 'filling-in' that underlies this phenomenon has an early or late cortical locus. Subjects viewed a display comprised of concentric rings that elicited apparent motion (two concentric rings presented in alternation), flicker (the same rings presented simultaneously), or real motion. We independently localized the cortical regions corresponding to the path of apparent motion in early visual areas (V1, V2, VP, V3, V4v, V3A), as well as the human motion processing complex (MT+). Cortical activity in the path of apparent motion in early visual areas was similar in amplitude during both apparent motion and flicker. In contrast, cortical activity in MT+ was higher in amplitude during apparent motion than during flicker, but was lower in amplitude than during real motion. In addition, we observed overlap in the cortical loci of MT+ and the lateral occipital complex (LOC), a region involved in shape and object processing. This overlap suggests that these regions could directly interact and thereby support perceived object continuity during apparent motion.